When functioning normally, the heart produces rhythmic contractions and is capable of pumping blood throughout the body. The heart has specialized electrical conduction pathways in both the atria and the ventricles that normally enable excitation impulses initiated from the sino-atrial (SA) node to be rapidly conducted throughout the myocardium. These specialized conduction pathways normally conduct depolarizations from the SA node to the atrial myocardium, to the atrio-ventricular node, and to the ventricular myocardium to produce a coordinated contraction of both atria and of both ventricles.
Cardiac rhythm management (CRM) devices have been developed that can provide electrostimulations to one or more heart chambers in an attempt to improve the rhythm or coordination of atrial or ventricular contractions. CRM devices can include circuitry to sense one or more signals from the heart. CRM devices can include an electrostimulation circuit for providing electrical stimulation to the heart. One or more leads can extend from the CRM device into a patient's heart chamber or into one or more veins of the heart. The lead can include one or more electrodes. The electrodes can be used to sense an electrical signal or to deliver electrical stimulation to the heart. This can include using one or more electrostimulation configurations for treating cardiac arrhythmias or dyssynchrony.
Sathaye et al. U.S Patent Application Publication No. US 2009/0043351 discusses a method and apparatus to perform electrode combination selection.
Ding et al. U.S. Pat. No. 6,704,598 discusses a cardiac rhythm management system selecting between multiple same-chamber electrodes for delivering cardiac therapy.